The Analysis Of The Correlation Between Stent Related Factors And Hepatic Encephalopathy After TIPS

Objective:Transjugular intrahepatic portosystemic shunt is used to cure the primary or secondary to portal hypertension and its complications.One of its most common complications is the Hepatic encephalopathy.It has serious influence the prognosis and life quality of patients after surgery.In here,we investigate the correlation between stent related factors including the placement of stents、amount of shunt after surgery、Postoperative portal vein pressure et al.and postoperative hepatic encephalopathy after transjugular intrahepatic portosystemic shunt,then to guide the selection of puncture point、diameter of stents etc.In the end,we want to improve operation method,reducing the incidence of postoperative hepatic encephalopathy,improving the success rate of surgery and the quality of prognosis.Methods:357 cases of surgery in gulou hospital affiliated to nanjing university from 2008 to 2016.2 were retrospectively analyzed.Collect the patient’s data,such as their gender,age,the causes of liver cirrhosis,history of EGVB,the situation of ascites,spleen surgery history,liver CTP classification,liver CTP grading and stent placement,stents diameter,preoperative portal vein pressure,velocity and other information,at postoperative day 5 and 1,3 months after the TIPS,we make the color doppler ultrasound imaging examination and record the follow-up of hepatic encephalopathy.We take out of the patients without enough preoperative data information when research and choose252 cases for statistical analysis.In the research,we use row*list to take chi-square analysis for intraoperative stents diameter and puncture position.Also,we use the 20%to group the postoperative portal vein pressure,portal vein pressure changes before and after operation and postoperative shunt,then take the chi-square analysis.After that,we use the single factor screening and multi-factor analysis of Logistic statistics to investigate the correlation between stent related factors and postoperative hepatic encephalopathy.Results:There are 57 cases occur postoperative hepatic encephalopathy,195 cases not.Among them,stents puncture the left,the trunk and the right branch of the portal vein,respectively have 85、90;77 cases,and 17、20、20 cases respectively occur of hepatic encephalopathy.We group postoperative shunt amount by average,respectively have 164、88 cases,and 36、21 cases respectively occur of hepatic encephalopathy and group postoperative portal vein pressure by average,respectively have118、134 cases,and 27、30 cases respectively occur of hepatic encephalopathy.Chi-square analysis results show that the intraoperative stents diameter,puncture position,postoperative portal vein pressure,portal vein pressure changes before and after operation and postoperative shunt amount not seen significant statistical significance,(P values were 0.362,0.369,0.231,0.536,0.231;P values were greater than 0.05).After that,we use the Logistics statistical analysis,the single factor analysis show that the stents puncture position,they shunt volume,postoperative portal vein pressure did not see obvious statistical significance(P values were 0.658,0.684,0.329,P values>0.05);Preoperative CTP score and grade of CTP and age is a risk factor for postoperative hepatic encephalopathy(P values were 0.044,0.042,0.006,P values<0.05),Multi-factor analysis results show that the stents puncture position,shunt volume,postoperative portal vein pressure and preoperative CTP score and CTP classification was not found obvious statistical significance(P value is 0.623,0.751,0.314,0.751,0.314,P values were greater than 0.05);Age is the independent influence factors of postoperative hepatic encephalopathy incidence(P value for OR value of 1.034,0.014).Conclusion:In this group of patients with TIPS,stented factors including stents puncture,diameter,amount of postoperative portal vein pressure,postoperative shunt and the hepatic encephalopathy after TIPS had no obvious correlation.